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General NPI Number Information
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NPI Number | 1487788824
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Entity Type | Organization
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Legal Business Name | ATLANTIC ORTHOPAEDICS, PA
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 08/06/2010
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Provider Practice Location Address
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Address Line | 1020 MASON AVE
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City | DAYTONA BEACH
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State | FL
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Zip | 32117
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Country | US
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Telephone | 386-760-0915
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Fax | 386-760-0084
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Provider Business Mailing Address
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Address Line | 1400 DUNLAWTON AVE STE 1-A
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City | PORT ORANGE
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State | FL
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Zip | 32127-8952
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Country | US
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Telephone | 386-760-0915
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Fax | 386-760-0084
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MRS. SHIRLEY K MUCK
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Credential |
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Telephone | 386-760-0915
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery
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License Number | ME0027133
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery
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License Number | ME0044566
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License Number State | FL
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